Crete Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

CRETE PHYSICAL THERAPY, LLC

Practice address

830 E 1St St
Crete, NE 68333-3108

Phone

(402) 826-2255

Fax

(402) 826-2288

NPI assigned

May 26, 2006

Last updated

Aug 18, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kellie Blackmon

Title

Administrator

Phone

(770) 748-0309

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Casey J. Moeller, DPT

  • Physical Therapist
  • Crete, NE
  • NPI 1205881471
  Medicare reassignment NPD
• Bryce Allen Rolenc, PT, DPT

  • Physical Therapist
  • Crete, NE
  • NPI 1750940839
  Medicare reassignment NPD
• Brian M Dinkelman

  • Physical Therapist
  • Hastings, NE
  • NPI 1396828836
  NPD (past)
• Brett I Smith

  • Physical Therapist
  • Nebraska City, NE
  • NPI 1619064300
  NPD (past)
• Thomas T Stootsberry

  • Physical Therapist
  • Lincoln, NE
  • NPI 1578650263
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1841246170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 294",
            "city": "CRETE",
            "state": "NE",
            "postal_code": "683330294",
            "telephone_number": "402-826-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 E 1ST ST",
            "city": "CRETE",
            "state": "NE",
            "postal_code": "683333108",
            "telephone_number": "402-826-2255",
            "fax_number": "402-826-2288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 E Highway 33",
            "address_purpose": "LOCATION",
            "city": "Crete",
            "state": "NE",
            "postal_code": "683335075",
            "country_code": "US",
            "telephone_number": "402-826-2255",
            "fax_number": "402-826-2288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRETE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-748-0309"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025366002",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025366000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crete Area Medical Center
• Crete Area Medical Center
• Crete Area Medical Center
• Crete Family Dental, LLC (Crete Family Dental)
• Crete Family Eyecare PC
• Crete Public Schools
• Carry R Crist, D.C,
• Julie M Crist, D.C.
• Taylor Eugene Densberger
• Angelica Diaz

• Physical Therapist in Crete, NE
• Providers in Crete, NE by specialty
• Physical Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.